Provider Demographics
NPI:1720263783
Name:THOMAS BOWHAY, M.D.
Entity Type:Organization
Organization Name:THOMAS BOWHAY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOWHAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-223-7040
Mailing Address - Street 1:1245 JACKSON GATE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9547
Mailing Address - Country:US
Mailing Address - Phone:209-223-7040
Mailing Address - Fax:209-223-7606
Practice Address - Street 1:1245 JACKSON GATE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9547
Practice Address - Country:US
Practice Address - Phone:209-223-7040
Practice Address - Fax:209-223-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902919665OtherNPI TYPE 1
00A453830OtherMEDICARE ID
CA00A453830Medicaid
CA00A453830Medicaid